Dr. Neal Mogk thinks he has found a better way to manage his medical practice that improves the service he provides to his patients.

Dr. Mogk, a board certified family practice physician, has decided to change his Beaver Street Family Practice to what he calls a concierge-style that, by reducing his patient roster, will give him more time to spend with each one.

I will be able to get to know my patients better, he said.

He said not everybody wants aggressive or interventional care. For example, some people with an aching shoulder might want to be treated with therapy and others may want a surgical fix.

Knowing the patient better will help him decide which treatment is best to suggest, he said.

Starting in January, he will charge each patient a $600 per year fee that lets them enjoy his concierge service. The fee can be paid in smaller installments. He will still bill a patients insurance and collect co-pays as before.

Signups will be on a first-come, first-served basis until the reduced roster is full. He said his patients who do not want to use the concierge service can still stay with the practice and be seen by Amy Clark, D.O. in his office or his nurse practitioner at no extra fee, he said.

24/7 PHONE ACCESS

The concierge service entitles the patient to longer office visits, guaranteed same-day appointments for urgent problems, house calls in Flagstaff area when needed, 24/7 phone calls returned personally unless he is out of town, and some other special treatment.

I found this interesting, and reflecting a lot of what I am seeing and thinking.

I foresee a chaotic and dystopian future for medical care in the US, with declining quantity and quality of health care available for all but the jet-setting elites. How long the decline will take remains obscured of course, but one thing is pretty much certain -- once the path is chosen, there is no turning back until a point of service collapse occurs. No matter how problematic a situation, interjecting a truculent bureaucracy (IRS administering health care? Really? Who's bright idea was that?) will surely take a problem and turn it into a catastrophe.

One thing I am trying to explore is the possibility for insurance programs that will reimburse for medical tourism once the medical care system here is in the crapper. If the ongoing dynamic is not reversed, sooner or later anyone with the means to do so will find the necessary health care elsewhere. I think giant medical cruise ships are definitely a reality in the not-too-distant future. If you have any knowledge about such plans, please let me know. (This of course presumes that travel is still legal, but given the bipartisan ruling cabal in DC I have to wonder...)

The war against e-e-e-e-vil rich doctors is just beginning, and I fully expect the end point to be single-payer with anything outside the system, like the example described in the article, declared as pirate medicine and the crackdown on the criminal medical scofflaws to be breathtakingly severe. And, the ongoing war against Big Pharma (believe me I am no friend of Big Pharma) by the political demogogues will ultimately spread to all sectors of research/innovation in the advance of medicine, and we will see a plateau of available medical technology. History shows us clearly that not much beneficial innovation occurs within a collectivist system.

Two weeks ago I needed to go to the medical clinic in the hinterboonies for a sinus infection Z-Pack. Suddenly I was struck by the reality that there are no practicing physicians in the whole county! ZERO!

I think a lot of doctors will go underground. They will have cash only practices and will go back to being the kind of doctors you used to see. Ones who care about their patients and try everything in their power to make them well. We, on the other hand, will be grateful for the care and will not expect unrealistic results.

My long-time doctor converted to a concierge service about five years ago and I followed him. So far it has worked great. I was even able to contact him on Christmas Day a few years ago, so sick I could hardly speak. He even called around until he found a pharmacy that was open. Many visits he doesn’t even charge me for, and he never charges the difference between his bill and the insurance reimbursement. All in all a great deal.

Am I missing something here? He's charging his patients $600 more per year to be on his special list. His patients healthcare cost just went up by $600 a year. Maybe that's less than ZeroCare, so it would still be the better deal.

My point is, his patients will be those who can afford his services (rich, congressmen, Presidents, etc.), while those who can't afford his services will be relegated to the mercy of ZeroCare.

9
posted on 10/27/2013 1:34:54 PM PDT
by jeffc
(The U.S. media are our enemy)

I see a different possibility. This doctor is making a bad mistake by continuing to accept insurance payments for his services. They still have huge paperwork demands.

No system of insurance will be practical if payments are made for routine things. Compare it to “grocery insurance”, that you pay a fixed amount of several thousand dollars every year, and instead of paying full price for groceries, you just pay a co-pay, say $20, for the groceries you *need*.

Importantly, I did not say *want*, but *need*. And it is up to the grocer and insurer to determine how much groceries you need. You see the irrationality of that, especially when the grocer has to fill out extended paperwork for each time you buy groceries?

Doctors have long been swamped with paperwork for taking Medicare and insured patients. Before, it was common to see a doctor, whose wife was his nurse, but also his receptionist and who kept his paper records in order. A two person team to run a medical office.

Today, a doctor may have to hire a nurse, and two or three receptionists, and two or three people to keep electronic records in order. Some even need an office manager to keep things running smoothly.

Doctors who reject Medicare and insurance payments can not only often afford to charge 50% less, but they make more money. The one sticking point being malpractice insurance.

The way to get a handle on malpractice is two fold. First, to limit awards to compensatory damages caused by the malpractice, not the underlying condition, and not punitive damages. Second, that a jury decision should be able to conclude that the malpractice is such that the doctor must undergo re-certification to continue to practice medicine.

This means that it is not up to sympathetic doctors on the state medical board to determine if he is a bad doctor. Just like a bad driver who has to take driving safety courses before he can drive again, the doctor must be re-certified. (This is a good way to go, because sometimes doctors develop medical or mental conditions where they should not continue to practice, but do. It became a severe problem when doctors developed AIDS dementia.)

Instead, insurance should be of two types: catastrophic and long term care. Right now insurers don’t want to offer long term care, so they will need incentives to do so, such as building long term care enclaves just south of the border in Mexico, which has an abundance of English speaking medical care people and far less expensive medicine.

Such enclaves would take a lot of the pressure off the system, as they could offer low prices for long term care, so there would be less demand for it in the states.

10
posted on 10/27/2013 1:36:05 PM PDT
by yefragetuwrabrumuy
(Welfare is the new euphemism for Eugenics.)

Doctors with more patients than time can try the concierge concept (it sort of implies to me that their patients have been being shortchanged; my doc takes whatever time is needed). I favor what other doctors are experimenting with: payment by cash/credit card only, payable at the time of service. No more micromanagement by insurance companies or government for “pre-approvals”. No three month delays getting paid and keeping up with 50 different price schedules. No need for 3 employees to process insurance and Medicare/Medicaid claims, and chase after deadbeats. In theory, they are able to actually practice medicine and charge significantly less. Not sure how it is working out for them.

Separation of consuming versus paying for services created much of the chaotic mess that is the American medical system. The government will definitely try to stop doctors from escaping institutional bondage. What if something like that caught on?

I think giant medical cruise ships are definitely a reality in the not-too-distant-future

It might well be so, as there's an excess of cruise ship capacity. It's not something I'd want to be on, though. There's already a problem on cruise ships with NorvoVirus and Legionnaire's. Why would I, in addition to those problems, want to be on a cruise ship full of sick people?

A better solution might be indian reservations if the feds get too heavy handed about their being alternatives to Obamacare. Getting healthy at a casino could be interesting.

I see the medical future as you do....dismal. EVERY DAY Obamacare is in place, the future gets worse. I'm seeing a future where medical care is based on public health issues, not individuals healing. It will be up to us to be aware of natural healing, good nutrition, healthy lifestyles, symptoms and home cures and first aid.

Although, I’m certainly not optimistic, there are certain silver linings associated with concierge, private fee for service medicine. Because the patient will increasingly be paying out of pocket, there will be a demand for competitive and value driven services. More emphasis will be on prevention and nutrition. As long as the police state remains at bay, conventional minimally invasive medical treatments and procedures will be performed in office and ambulatory surgery centers at prices below the enormous deductibles, premiums and co-pays required under existing insurance and 0-care insurance plans.
I think that it’s really up to the states to safeguard competitive private medicine, and I believe that more than a few will do just that. States that opt for the exchanges, expanded Medicaid and restrictions on private medicine will have horrible and woefully inadequate healthcare systems and it won’t take long for the differences to become apparent.

14
posted on 10/27/2013 1:45:55 PM PDT
by grumpygresh
(Democrats delenda est. New US economy: Fascism on top, Socialism on the bottom.)

I have asked about using cash (before I got insurance last year) and they would only give me a 5% discount off full price care. Having worked in insurance, I would have thought the least they could offer is whatever an insurance company would pay after adjustments, but, nope. smh

15
posted on 10/27/2013 1:51:35 PM PDT
by ozaukeemom
(Is there even a republic left?)

Had a big medical expense year. Had a couple of scans that my insurance company did not cover. Asked the provider what was the best deal if I paid that day. One cut a 2K plus bill down to $1100 for cash. Another gave me a 64 % discount.

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